Changes to Hospitalization Rates posted on Home Health Compare Beginning January 2013
Monday, December 17, 2012
by: VNAA Quality and Education Team

Section: Quality and Educational Programming

In the Centers for Medicare and Medicaid Services (CMS) final rule for the CY 2013 home health prospective payment system update, effective January 1, 2013, there will be significant changes in how the home health hospitalization rates are calculated. Rates will be calculated using Medicare claims instead of using OASIS data. Specifically, the Acute Care Hospitalization and Emergency Department (ED) Use Without Hospitalization measures will replace the OASIS-based measures, and will use the Medicare claims data as the data source.

Some significant changes are:
  • Claims-based measure is based on the Start of Care (SOC) date instead of the transfer/discharge date.
  • The measures address outcomes of HHA patients in a fixed interval after the start of their home health care, regardless of the length of their home health stay.
    • Planned hospitalizations are excluded from the acute care hospitalization claims-based measure numerator.
    • Observation stays that begin in a hospital emergency department but do not result in an inpatient stay within the 60 days after the start of home health care are counted in the ED Use without Hospitalization measure.
    • Observation stays that result in an inpatient stay within the 60 days after the start of home health care are counted in the Acute Care Hospitalization measure even if the patient is discharged from the home health agency.
  • The claims measure denominator is the number of all home health stays.
  • Claims-based measure applies to Medicare Fee-for-Service (FFS) patients only while the OASIS-based measure applied to Medicare FFS, Medicare Advantage, and Medicaid patients.
  • LUPAs are excluded from claims-based measure.
There is significant difference in the two sources of data for these measures and so the results from the claims-based measure will probably not be comparable to the OASIS-based measure results. However, the information that an agency obtains through the CASPER reports includes the claims-based rate as well as the OASIS-based rate in individual reports. The OASIS-based result will continue to be reported on the CASPER Reporting System.

To review this section on page 67092-67094 of the final rule, please click here
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